脊髓型颈椎病颈前路手术后纵韧带切除的临床研究-外科学(骨外)专业论文.docxVIP

徐州医学院硕士学位论文缩略词表 徐州医学院硕士学位论文 缩略词表 CSM Cervical Spondylotic Myelopathy 脊髓型颈椎病 JOA Japan Orthopetic Association 日本矫形外科协会 RR Recovery Rate 改善率 CSL P Cervical Spine Locking Plate 颈椎带锁钢板 ACPS Anterior Cervical Plate System 颈前路内固定系统 SEH Spinal Epidural Hematoma 硬膜外血肿 2 徐州医学院硕士学位论文脊髓型颈椎病颈前路手术后纵韧带切除的临床研究 徐州医学院硕士学位论文 脊髓型颈椎病颈前路手术后纵韧带切除的临床研究 摘要 目的：观察颈椎后纵韧带在脊髓型颈椎病中对脊髓的压迫作用，分析后纵韧带切 除在颈前路手术中的临床疗效。方法：将2003年3月．2005年12月间因脊髓型 颈椎病行颈前路减压且术后有M砒检查结果的患者随机分为两组，其中行颈椎后 纵韧带切除组12例，未行切除组20例。后纵韧带切除组，先纵向切除一半的后 纵韧带，观察切除后纵韧带侧及未切除后纵韧带侧硬膜囊的形态及刮除骨赘后后 纵韧带的漂浮状况，最后完全切除后纵韧带。分析32例行颈前路减压患者的术后 MRI检查资料，按照日本骨科协会(JOA)评分系统进行临床疗效评价，利用MRI技 术测量脊髓矢状径并进行比较。结果：：后纵韧带切除侧硬膜囊向前膨出形态恢复 良好。未切除后纵韧带侧，硬膜囊均不同程度受后纵韧带的压迫，刮除椎体上下缘 骨赘后后纵韧带向前的漂浮有限，不足以很好地恢复硬膜囊的形态。完全切除后纵 韧带后，硬膜囊形态恢复良好。随访3—24个月，MRI显示后纵韧带切除组术后与术 前脊髓矢状径差值大于未行后纵韧带切除组(PO．01)，后纵韧带切除组术后与 术前JOA评分差值大于未行后纵韧带切除组(P0．01)，后纵韧带切除组术后较术 前脊髓功能改善率大于未行后纵韧带切除组(PO．05)。结论：颈椎退变增生的后 纵韧带是脊髓型颈椎病中脊髓致压的重要因素之一；颈椎前路切骨减压时行增生 后纵韧带切除可使病变节段减压更加彻底，有利于脊髓型颈椎病患者脊髓形态的 恢复，临床疗效明显。 [关键词]后纵韧带：脊髓型颈椎病：切除：临床疗效 徐州医学院硕士学位论文Clinical 徐州医学院硕士学位论文 Clinical research of the resection of the posterior longitudinal ligament in the anterior cervical operation of cervical spondylotic myelopathy Abstract objective：To observe the compression of the posterior longitudinal ligament(PLL)on the spinalcord in cervical spondylotic myelopathy(CSM)and to analyze the clinical effect after the anterior cervical operation～Method：hl 32 cases of CSM treated with anterior cervical operation from March 2003 to December 2005，patients were divided into PLL removal group with 12 cases and PLL unremoval group wi血20 cases at random．In PLL removal group，one half of the PLL were resected longitudinally．The shape of the durasac were observed after removed the PLL side．The effect of the “flow”of the PLL were observed after removal of the posterior osteophyte of the vertebral body．Lastly,complete resection of the PLL were done．The MRI of 32 patients who underwent cervical decompression due to CSM were analyzed．The Japanese Orthopedic Assoc